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Hawthorne BC, Engel S, McCarthy MBR, Cote MC, Mazzocca AD, Coyner KJ. Biologic Adjuvants to Rotator Cuff Repairs Induce Anti-Inflammatory Macrophage 2 Polarization and Reduce Inflammatory Macrophage 1 Polarization In Vitro. Arthroscopy 2024:S0749-8063(24)00337-2. [PMID: 38735413 DOI: 10.1016/j.arthro.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To examine the effect of various biologic adjuvants on the polarization of macrophages in an in vitro model for rotator cuff tears. METHODS Tissue was harvested from 6 patients undergoing arthroscopic rotator cuff repair. An in vitro model of the supraspinatus and subacromial bursa was created and treated with control, platelet rich plasma (PRP), autologous activated serum (AAS), or a combination of PRP+AAS. The effect of treatment on macrophage polarization between M1 pro-inflammatory macrophages or M2 anti-inflammatory macrophages was measured using gene expression, protein expression, flow cytometry and nitric oxide (NO) production. RESULTS Tendon and bursa treated with PRP, AAS and PRP+AAS significantly decreased the gene expression of M1 markers IL-12 and TNF-a, while significantly increasing the expression of M2 markers Arginase, IL-10 and TGF-b (p<0.05) compared to treatment with control. ELISA analysis of protein production demonstrated that compared to control, co-culture treated with PRP, AAS and PRP+AAS significantly decreased markers of M1-macrophages (IL-6, IL-12, and TNF-a), while significantly increasing the expression of markers of M2-macrophages (Arginase, IL-10, and TGF-b) (p<0.05). Flow cytometry analysis of surface markers demonstrated that compared to control, tendon and bursa treated with PRP, AAS and PRP+AAS significantly decreased markers of M1-macrophages (CD80, CD86, CD64, CD16), while significantly increasing the expression of markers of M2-macrophages (CD163 and CD206) (p<0.05). Treatment of the co-culture with PRP, AAS and PRP+AAS consistently demonstrated a decrease in NO production (p<0.05) compared to control. AAS and PRP+AAS demonstrated an increased macrophage shift to M2 compared to PRP alone, whereas there was not as uniform of a shift when comparing PRP+AAS to AAS alone. CONCLUSIONS In an in vitro model of rotator cuff tears, the treatment of supraspinatus tendon and subacromial bursa with PRP, AAS and PRP+AAS demonstrated an increase in markers of anti-inflammatory M2-macrophages and a concomitant decrease in markers of pro-inflammatory M1-macrophages. AAS and PRP+AAS contributed to a large shift to macrophage polarization to the anti-inflammatory M2 compared to PRP.
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Affiliation(s)
| | - Sam Engel
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT
| | | | - Mark C Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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Gruber R. How to explain the beneficial effects of platelet-rich plasma. Periodontol 2000 2024. [PMID: 38600634 DOI: 10.1111/prd.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/19/2024] [Accepted: 03/02/2024] [Indexed: 04/12/2024]
Abstract
Platelet-rich plasma (PRP) is the platelet and leukocyte-containing plasmatic fraction of anticoagulated autologous blood. While evidence supporting the clinical use of PRP in dentistry is low, PRP is widely used in sports medicine, orthopedics, and dermatology. Its beneficial activity is commonly attributed to the growth factors released from platelets accumulating in PRP; however, evidence is indirect and not comprehensive. There is thus a demand to revisit PRP with respect to basic and translational science. This review is to (i) recapitulate protocols and tools to prepare PRP; (ii) to discuss the cellular and molecular composition of PRP with a focus on platelets, leukocytes, and the fibrin-rich extracellular matrix of coagulated plasma; and finally (iii) to discuss potential beneficial effects of PRP on a cellular and molecular level with an outlook on its current use in dentistry and other medical fields.
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Affiliation(s)
- Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Wu Y, Peng G, Wang Y, Chen J, Zhang B, Tang J, Cheng B. Clinical efficacy of blood derivatives on wound healing: A systematic review and network meta-analysis. Int Wound J 2024; 21:e14622. [PMID: 38158884 PMCID: PMC10961890 DOI: 10.1111/iwj.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
This study aims to evaluate the clinical effects of different blood derivatives on wound healing using network meta-analysis. PubMed, Embase, OVID, Web of Science, SCOPUS and Cochrane Central were searched to obtain studies about blood derivatives on wound healing until October 2023. R 4.2.0 and Stata 15.0 softwares were used for data analysis. Forty-four studies comprising 5164 patients were included. The results of network meta-analysis showed that the healing area from high to low was GF + ORCCB, ORCCB, GF, PRF, Unnas paste dressing, APG, PRP injection, PRP, PRP + thrombin gel, PPP, HPL, CT. The healing time from low to high was PRP + thrombin gel, GF, PRP, PC + K, PC, APG, PRF, CT, Silver sulfadiazine ointment. The number of patients cured from high to low was APG, PRP injection, PRP, Aurix, PRF, Leucopatch, HPL, Antimicrobial Ointment Dressing, CT, 60 μg/cm2 repifermin, 120 μg/cm2 repifermin, AFG, PPP. The order of analgesic effect from high to low was AFG, Aminogam gel, PRF, PRP, Oxidised oil, APG, GF, CT. The order of the number of wound infection cases from low to high is APG, 20 μg/cm2 repifermin, 60 μg/cm2 repifermin, PRP, LeucoPatch, CT, PPP, Antiseptic ointment dressing. Healing area: GF + ORCCB had the best effect; Healing time: PRP + thrombin gel took the shortest time. The number of cured patients and the reduction of wound infection: APG has the best effect. Analgesic effect: AFG has the best effect. More studies with large sample sizes are needed to confirm the above findings.
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Affiliation(s)
- Yanhong Wu
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Guang Peng
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Yuzhi Wang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Jianwu Chen
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Bin Zhang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Jianbing Tang
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
| | - Biao Cheng
- Department of Burns and Plastic SurgeryGeneral Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina
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Peng Y, Wang J, Liu X, Zhou Y, Jia S, Xu J, Zheng C. Efficacy of Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2024; 98:365-373. [PMID: 37355015 DOI: 10.1016/j.avsg.2023.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The probiological healing effect of platelet-rich plasma (PRP) during tissue repair has recently gathered much attention. This study aimed to conduct a systematic review and meta-analysis of patients with diabetic foot ulcer (DFU) receiving PRP or conventional treatment to evaluate their efficacy. METHODS PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were comprehensively searched by 2 independent reviewers following PRISMA guidelines for the inclusion of randomized controlled trials (RCTs) comparing PRP with conventional treatments for DFUs. The primary measurements of healing rate and healing time, the methodological quality and extracted data were assessed using Review Manager 5.3. Statistical significance was set at P < 0.05. RESULTS A total of 10 RCTs involving 550 patients were included in this study, PRP was observed to significantly improve the healing rate (risk ratio [RR] = 1.38, 95% confidence interval [CI] 1.05-1.82, P = 0.02) and shorten the healing time (mean difference [MD] = -23.23, 95% CI -45.97 to -0.49, P = 0.05) of patients with DFU when compared to the conventional treatment. CONCLUSIONS Compared to conventional treatment, PRP effectively promoted the healing of patients with DFU by evidently improving the healing rate and healing time.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - JiePing Wang
- Laboratory of Exercise Biochemistry, Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Xinyao Liu
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Yanqing Zhou
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Jinrong Xu
- Hospital of Central China Normal University, Wuhan, China.
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China.
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Peng Y, Du L, Yang B, Fan D, Jia S, Zheng C. Efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta-analysis. PM R 2023; 15:1643-1653. [PMID: 37526570 DOI: 10.1002/pmrj.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Basic scientific studies have demonstrated positive effects of platelet-rich therapies, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), on tendon repair. However, clinical evidence indicating improved prognosis is controversial. In this study, we aimed to determine whether augmentation of arthroscopic rotator cuff repair with PRP and PRF improves outcomes compared to arthroscopic repair alone. LITERATURE SURVEY PubMed, Embase, and Cochrane library databases were comprehensively searched for randomized controlled trials (RCTs) published until June 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No language restriction was applied. METHODOLOGY The primary outcomes were the rate of repeat tears after arthroscopic rotator cuff repair (retear rate) and clinical function scores (Constant-Murley Score, University of California, Los Angeles Score), and the extracted data were assessed for quality. Statistical analyses were performed using Review manager 5.3, and p < .05 was considered statistically significant. SYNTHESIS Ten RCTs with 628 patients were included. The results showed that augmenting surgery with PRP reduces retear rates compared to surgery alone (risk ratio [RR] = 0.40, 95% confidence interval [CI] 0.23-0.69, p = .001), whereas PRF has no effect on retear rates (p = .92). Regarding clinical function, PRP improves Constant-Murley scores (mean difference [MD] = 2.03, 95% CI 0.13-3.93, p = .04) and University of California, Los Angeles scores (MD = 1.30, 95% CI 0.36-2.24, p = .007), whereas PRF improves only Constant-Murley scores (MD = 3.93, 95% CI 1.50-6.36, p = .002). However, these differences were small and below the minimum clinically important difference threshold. CONCLUSIONS This study showed that compared to arthroscopic rotator cuff repair alone, the application of PRP in arthroscopic rotator cuff repair reduces retear rate and improves clinical function scores, whereas the application of PRF has no clinically meaningful benefit. The small number and heterogeneity of studies as well as methodological limitations and risk of bias limit confidence in the true effect.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liang Du
- Department of Rehabilitation Medicine, PLA Middle Military Command General Hospital, Wuhan, China
| | - Bowen Yang
- Division of Pediatric Healthcare, Department of Pediatrics, Children's Rehabilitation Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Donghao Fan
- Department of Rehabilitation Medicine, People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Pan L, Li C, Wang Z, Yang L, Zhang L. Preparation of an antibacterial dressing for simultaneous delivery of polyhexamethylene biguanide and platelet-rich plasma, and evaluation of the dressing's ability to promote infected skin repair. Biochem Eng J 2022. [DOI: 10.1016/j.bej.2022.108626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karsmarski OP, Hawthorne BC, Cusano A, LeVasseur MR, Wellington IJ, McCarthy MB, Cote MP, Mazzocca AD. Activated Serum Increases In Vitro Cellular Proliferation and Growth Factor Expression of Musculoskeletal Cells. J Clin Med 2022; 11:jcm11123442. [PMID: 35743510 PMCID: PMC9225433 DOI: 10.3390/jcm11123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to investigate proteomic alteration that occurs to whole blood when converted to activated serum (AS) using an autologous thrombin system. This study further sought to evaluate the functional in vitro effect of AS on tenocytes, chondrocytes, subacromial bursal cells, and osteoblasts. The peptide/protein composition of AS was analyzed by liquid chromatography−mass spectrophotometry (LC-MS). The cell lines were treated with AS, and cellular proliferation was quantified 48 h after treatment. Platelet-derived growth factor (PDGF), insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), interleukin-1 beta (IL-1β), and interleukin-1 receptor antagonist (IL-1Ra) were quantified utilizing enzyme-linked immunosorbent assays (ELISAs). LC-MS identified 357 proteins across the AS and whole blood. Fifty-four of the proteins identified had significant differences between the relative protein abundance of the AS samples compared to whole blood. Treatment with AS in all cell lines significantly increased proliferation compared to control cells at 48 h. Increased PDGF, VEGF, and IGF-1 in all cell lines exposed to AS compared to the control (p < 0.05) were observed. These findings suggest that treatment with AS increases in vitro cellular proliferation and the release of growth factors that may play a role in tissue repair.
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Smith BL, Matuska AM, Greenwood VL, Gilat R, Wijdicks CA, Cole BJ. Autologous Fibrin Sealants Have Comparable Graft Fixation to an Allogeneic Sealant in a Biomechanical Cadaveric Model of Chondral Defect Repair. Arthrosc Sports Med Rehabil 2022; 4:e1075-e1082. [PMID: 35747626 PMCID: PMC9210474 DOI: 10.1016/j.asmr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this study is to assess the integrity of chondral defect repairs filled with a cartilage allograft and sealed with either allogeneic fibrin sealant or autologous fibrin sealants created with platelet-rich plasma (PRP) or platelet-poor plasma (PPP) in a cadaver model. Methods Twenty-millimeter medial femoral condyle (MFC) chondral defects were created in five human cadaveric knees. The defects were filled with particulated cartilage allograft hydrated with PRP from human donors until slightly recessed. Sealants were applied until flush with the articular surface using PRP and autologous thrombin serum, PPP and autologous thrombin serum, or commercial allogeneic sealant. The MFC defects were cycled using a multiaxial testing system to simulate continuous passive motion undergone during rehabilitation. After testing, the repairs were assessed for integrity by quantitatively comparing defect exposure and qualitatively assessing sealant delamination. Results The mean defect exposures were 4.20% ± 5.02% for the PRP group, 4.60% ± 5.18% for the PPP group, and 1.80% ± 2.95% for the allogeneic sealant group. No significant differences were observed between groups (P = .227), and each group had significantly less defect exposure when compared to the critical clinically relevant value assigned to be 30% (P = <.001 for all). No complete sealant delamination was observed, although the allogeneic sealant delaminated with a higher magnitude than did the autologous sealants. Conclusions The PRP and PPP sealants were comparable to the allogeneic sealant for graft fixation when used in conjunction with an underlying PRP-hydrated particulated cartilage allograft. The autologous sealants had better delamination resistance than the allogeneic sealant. Clinical Relevance The time-zero model is critical in elucidating the retention properties of fibrin and allogenic sealants after cartilage repair and before healing processes help stabilize the repair.
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Affiliation(s)
- Benjamin L. Smith
- Department of Orthopedic Research, Arthrex, Inc., Naples, Florida, U.S.A
| | | | | | - Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv
| | - Coen A. Wijdicks
- Department of Orthopedic Research, Arthrex, Inc., Naples, Florida, U.S.A
| | - Brian J. Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Brian J. Cole, M.D., M.B.A., Midwest Orthopaedics at Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL 60612, U.S.A.
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